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HomeMy WebLinkAboutBLD2014-00145 BLD14-00145 BUILDING PERMIT APPLICATION Review Type: Jefferson County Department of Community Development 621 Sheridan Street Port Townsend, WA 98368 PERMIT#: BLD14-00145 Received Date: 4/28/2014 SITE ADDRESS: 200 WERNER RD PORT LUDLOW, 98365 OWNER: STEVEN M LUNDE PHONE: 360-379-0329 THERESAA LUNDE 64 EMILY J LN NORDLAND WA 98358-9560 SUBDIVISION: Block: Lot: PARCEL NUMBER: 821082008 Section: 8 Township: 28 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: REPRESENTATIVE: PHONE: PROJECT DESCRIPTION FOUNDATION PERMIT ONLY FOR EXISTING STRUCTURE: 364 sq ft, no heat, no plumb TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP REP MAIN: 364 VALUATION 1,000.00 ADD'L: HEAT TYPE: UH CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: BEDROOMS: BATHROOMS: Exist: Exist: Prop: Prop: Total: Total: Routing Date: Type Amount Paid By: Date: Receipt: Approved/Date Total: APPROVED Jefferson County ;}CC: \\4irinmmrlArh4m\fnrnse% RI Il Ann PIA rn+ A/9R WWII A q SPARTMENT OF co ViY DEVELOPMENT 621 Sheridan Street Port Townsend,WA 98368 Web:www.coiefferson.wa.us/communitydevelopment Tel:360.379.4450 I Fax:360.379.4451 I Email:dcd(c co.iefferson.wa.us Building Permits&Inspections J Development Consistency Review I Long Range Planning I Watershed Stewardship Resource Center Master Permit Application MLA: Project Description(include separate sheets as necessary): 2e pl aee. ate} 4 aet4,4► ,v k. `vn ua i4-e" C:a,i cre. Fv.t.n4 -4^ Tax Parcel Number: Rai 0 geg, 00A Property Size: r A0-6,.$ (acres/square feet) Site Address and/or Directions to Property: 1 1 Iwo W0,11 r � Po r+ Lut lvuJ ( su..)(;,1so U ltd Property Owner(s)of Record: SA-L(1'■IR+i Er "CLltv�as c. Lit N d it Telephone: 3400 3r1'i O3 VI Fax: email: SAe rLut &12#4SQJ:watt Mailing Address: 4 SAi c rM a, • yli A Applicant/Agent(if different fran owner): Telephone: Fax: email: Mailing Address: What kind of Permit?(Check each box that applies ❑ Lot or Road Segregation RBuilding ❑Critical Areas Stewardship Plan ❑ Demolition Permit ❑Variance(Minor,Major or Reasonable Economic Use) if Single Family ❑Garage Attached/Detached ❑Conditional Use[C(a),C(d),or C]** ❑ Manufactured Home El Modular ❑ Discretionary"D"or Unnamed Use Classification ❑ Commercial* ❑Special Use(Essential Public Facilities)** ❑ Change of Use ❑Boundary Line Adjustment O Address 0 Road Approach ❑Short Plat" O Home Business ❑Cottage Industry ❑Binding Site Plan" ❑ Propane 0 Long Plat** ❑Sign ❑Planned Rural Residential Development(PRRD)/Amendments** ❑Allowed"Yes"Use Consistency Analysis ❑Plat Vacation/Alteration** ❑Stormwater Management ❑Shoreline Master Program Exemption/Pemtit Revisions" ❑Site Plan Approval Advance Determination(SPAAD)* 0 Shoreline Management Substantial Development** ❑Temporary Use ❑Shoreline Management Variance O Wireless Telecommunication* ❑Comprehensive Plan/UDC/Land Use District Map Amendment ❑ Forest Practices Act/Release of Six-Year Moratorium ❑Jefferson County Shoreline Master Program Amendment *May require a Pre—Application Conference ❑Tree Vegetation Request **Requires a Pre-Application Conference Please identify any other local,state or federal permits required for this proposal, if known: DESIGNATION OF AGENT I hereby designate to act as my agent in matters relating to this application for permit(s). OWNER SIGNATURE Date: By signing this application form,the owner/agent attests that the information provided herein,and in any attachments,is true and correct to the best of his,her or its knowledge. Any material falsehood or any omission of a material fact made by the owner/agent with respect to this application packet may result in this permit being null and void. I further agree to save,indemnify and hold harmless Jefferson County against all liabilities,judgments,court costs,reasonable attorney's fees and expenses which may in any way accrue against Jefferson County as a result of or in consequence of the granting of this permit. I further agree to provide access and right of entry to Jefferson County and its employees,representatives or agents for the sole purpose of application review and any requi later inspection Staffs access and right of entry will be assumed unless the applicant informs the County in writing at the time of the applicaf./hat he or she jam prior notice. . , Signature: _ GA1 _ �: Date: The action or actions Applicant will undertake as a result of the issuance of this permit may negatively impact upon one or more threatened or endangered species and could lead to a potential"take"of an endangered species as those terms are defined in the federal law known as the "Endangered Species Act"or"ESA."Jefferson County makes no assurances to the applicant that the actions that will be undertaken because this permit has been issued will not violate the ESA. Any individual,group or agency can file a lawsuit on behalf of an endangered species regarding your action(s)even if you - e in complian. ' h the Jefferson County development code.The Applicant acknowledges that he,she or it holds individual and non-transfera. responsib' ,. .•hart • to and complying with the ESA- The Applicant has read this disclaltner and signs and dates it below. Signature: ! ` 42 T; / 4, ark Date: - DUILUtHbIAItMtNI The signer of this statement does her,k certify they are the Owners of the parcel referenced herein.they are not licensed contractors and that they will be assumi - respo ''. ;•f the General Contractor for the proposed project. /i Signature: :!, � ?LfA"1 Date: GENERAL CONTRACTOR OR MANUFACTURED HOME INSTALLER: PHONE: FAX: ( ) ( ) MAILING ADDRESS: EMAIL: CONTRACTOR'S LICENSE WAINS NUMBER: NUMBER ARCHITECT/ENGINEER: PHONE ( ) FAX:( ) MAILING ADDRESS: EMAIL Project Type: Frame Type: Bathrooms: Shoreline: Type of Sewage Disposal: ❑ New .4' Wood Existing: 0 ❑ Sewer ❑ Addition ❑ Steel Proposed: !3 Bank 0 Community System ❑ Alteration/Remodel ❑ Concrete Total: C) Height: ❑ Individual System A Repair ❑ Masonry SEP Permit# ❑ Demolition ❑ Other: Bedrooms: Water Supply: Existing: Setback: ❑ Private well ❑ Two Party Pro d: Type of Heat: posed: d Name of System: If this is a Commercial Project you must answer the following: Number of Parking Spaces: Current: Proposed: Number of ADA Parking Spaces: Number of occupants(includes owners,tenants,employees,etc) Current Proposed IBC Occupancy: IBC Type of construction: Will you have Food Service? Yes / No If this is a Propane Tank and/or Appliance Installation permit,mark all items below that apply: Underground Tank Above ground tank Size of Propane Tank: - Heat Stove Cook Stove Woodstove Fireplace.nsert rehtO i evotS telleP ,i knaT retaW toH i Is this appliance being installed in a Manufactured/Mobile Home? Yes / No When applying for a permit to install a propane tank you must also submit a site plan showing all of the buildings,all property lines,tank location and size,distances from the propane tank to all property lines,buildings and septic system components, including the reserve area. Square Footage Current Proposed For Office Use Only Amount Revision Main Floor Heated EH Bld App Review: 21-1°Floor Heated Consistency Review: Other Heated ® Base fee: t L /rI Mezzanine Additional Section: ''r 11 Heated Basement © Plan Check fee: z , -So Unheated Basement State Surcharge fee: Other Unheated � � Pot Water Review fee: Garage/Carport Q SUBTOTAL 62_ .66-D l 47 Decks 911/Rd Approach fee: Other 0 a TOTAL: $ Receipt Number: I(it 1( V ( , Cash/Check Number: 2 ESTIMATED COST(REQUIRED) Date: 4/n �� .Fair rket value of all labor and materials foundation to finish f 0000 00 Initials: • • Jefferson County Building Division Permit Number: BLD14-00145 Applicant: LUNDE BUILDING PERMIT INSPECTION APPROVALS Applicable Code: 2012 International Building Codes To schedule inspections, call (360)379-4455 no later than 3:00PM the day before the inspection is needed. Requests received after 3:00 PM will not be scheduled for the next day's inspections. ELECTRICAL PERMITS are issued by the Washington State Department of Labor& Industries. The electrical permit must be signed off by the State Inspector prior to the County's Framing Inspection Inspection Item Date Approval Signature Notes Setbacks 8h9/41 ck Foundation Footing f3/,9f ist ,/�rrro� INS.rA'L- J) Footing Drains t.[ 04, $/ 2& /'f A final inspection will not be scheduled until all of the following are completed and signed off by the applicable Department: • Building Permit Conditions are met • Septic Permit Final/Complete for any building containing plumbing • Land Use Conditions met and signed off • Public Works Permit Final(where applicable) FINAL INSPECTION ( 4)a1 FINAL INSPECTION MUST BE APPROVED PRIOR TO BUILDING BEING OCCUPIED THIS PERMIT IS VALID FOR ONE YEAR S CONDITIONS for Building Permit# : \\tidemark\data\forms\F_BLD_Permit_BIdg.rpt 4/28/2014 4 • • BUILDING PERMIT Jefferson County Department of Community Development 621 Sheridan Street, Port Townsend, WA 98368 (360)379-4450 FAX (360)379-4451 PERMIT#: BLD14-00145 Received Date: 4/28/2014 SITE ADDRESS: 200 WERNER RD Issue Date 4/28/2014 PORT LUDLOW, 98365 Expiration Date 4/28/2015 OWNER: STEVEN M LUNDE PHONE: 360-379-0329 THERESAA LUNDE 64 EMILY J LN NORDLAND WA 98358-9560 SUBDIVISION: Block: Lot: PARCEL NUMBER: 821082008 Section: 8 Township: 28 N Range: 01 E CONTRACTOR: OWNER/BUILDER PHONE: PROJECT DESCRIPTION: FOUNDATION PERMIT ONLY FOR EXISTING STRUCTURE: 364 sq ft, no heat, no plumb TYPE OF WORK RES SQUARE FOOTAGE: TYPE OF IMP REP MAIN: 364 VALUATION 1,000.00 ADD'L: HEAT TYPE: UH CODE EDITION: 2012 HEAT BASE: HEAT TYPE: OCCUPANCY: UNHEATED: #OF STORIES: OCCUPANCY: OTHER: CONST TYPE: GARAGE: SHORELINE: CONST TYPE: DECK: SETBACK: BANK HEIGHT: SEWAGE DISPOSAL: WATER SYSTEM: Type Amount Paid By: Date: Receipt: BEDROOMS: BATHROOMS: Permit $42.00 MEB 04/28/14 148613 Exist: Exist: Plan Check $27.30 MEB 04/28/14 148613 Prop: Prop: State Building Code $4.50 MEB 04/28/14 148613 Total: Total: Total: $73.80 Directions to Site: HEALTH DEPARTMENT AND PUBLIC WORKS APPROVAL REQUIRED PRIOR TO FINAL INSPECTION THIS PERMIT IS VALID FOR ONE YEAR OR IT MUST BE PROPERLY RENEWED BUILDING INSPECTION HOT-LINE 379-4455. Request must be received by 3pm the day before the inspection is needed. Office Hours 9:00 am -4:30 pm MONDAY - THURSDAY HOT LINE AVAILABLE 24 HOURS A DAY I ■ f G• JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT -4,,,,G,° Date: f( -jg Time Received: 7,-7 (SD/Pm Mon. Tue. Wed. 412, Fri. Date: /(-2__O BLD: /I/— / Contact Name: Owner: Contact Number: 360 73/ 0 2.5 y Address: AO (4).e.4(14 .- g-P 206 1 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection `J Setbacks Floor Foundation Wall Address Posted Block &Tile Ceiling �SU: - 2 - . .k X64. JEFFERSON COUNTY DEPARTMENT OF COMMUNITY DEVELOPMENT / Date: q g Time Received: il418 am/pm Mon. t.0 Wed. Thur. Fri. Date: 9 BID: ((fr (`15. Contact Name: Owner: LC,1,14e- Contact Number: 360 '73( 0 Z5 Address: .p wet-o. 206 Notes: •F(6, b r�,t c& Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection - Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling 4. ON CQ il ry_ G. JEFFERSON COUNTY 1 DEPARTMENT OF COMMUNITY DEVELOPMENT '5'HrNG-CO? T / Date: ¶-2,Time Received: 1 lC1 a IC' Mon. all Wed. Thur. Fri. Date: 0-2L BLD: If- I4, Contact Name: Owner: Contact Number: 360 7Y/ D25-y Address: _Do \.4)-( 14-6K- K 206 Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection - Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling g4,¢SON e WA JEFFERSON COUNTY 4 " o.� DEPARTMENT OF COMMUNITY DEVELOPMENT If INGS Date: I 4 f 4 Time Received: 1 O. 3o , am/(0 Mon. 60 ed. Thur. Fri. Date: y BLD: 14- ob 1 4 S� Contact Name: Owner: i Li n CUL Contact Number: 360 "73 — 112.54 Address: dia Ill e r (CO .-28ra Notes: Foundation Plumbing Framing Propane Tank Mechanical Setbacks Under-ground Framing Under ground Furance Footing Rough In Air Seal Above ground Gas Stemwall Hydronic Exterior shear Exterior lines Oil Straps Hot Water Htr Interior shear Interior lines Ducts Post Hole Ventilation Appliance Underfloor Gas/Wood stove Man-Homes Insulation Final Inspection Setbacks Floor Foundation Wall Address Posted Block&Tile Ceiling Inspections are required to be called in by 3:00 pm to receive an inspection the next day. Do to staffing issues, at this time,we cannot guarantee that you will receive an inspection the next day. day. Unless you receive a call from us,assume we will arrive on your requested inspection day. You may leave an inspection request 24 hours a day, and Inspections are available from Monday through Friday. • We cannot determine the time we will arrive in advance. However, if you call our office the morning of your inspection,around 9:00 a.m.,we can give an estimate of when the inspector will arrive. Our general office phone number is 360 379-4450. • An approved set of plans are to be on site with building permit for all inspections. If permit and plans are not on site at time of inspection,a re-inspection fee must be paid prior to re-scheduling another inspection. If no access, no inspections will be performed,and a re-inspection fee must be paid prior to re-scheduling another inspection. . Inspectors will not access a home that has personal affects inside when the owner is not present. • Commercial projects require 24 hour notice for inspection. � T F-----jll q V i 1 <°' ..... 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